High psychosocial impact of complications, suboptimal coping strategies, and burnout among spine surgeons.

Abstract

Background context: Complications in spine surgery are unavoidable. Apart from the patients' suffering, complications can profoundly affect surgeons' emotional well-being. Though medical literature discusses extensively about handling the medical aspect of complications, the real psychological impact of complications on spine surgeons is less discussed.

Purpose: To evaluate the emotional burden of complications, psychological impact, coping strategies, and burnout among spine surgeons.

Study design: Cross-sectional survey-based study.

Patient sample: Total of 50 practicing spine surgeons.

Methods: An anonymous cross-sectional survey including 35 questions covering seven psychological domains was shared with 50 spine surgeons. The structured questionnaire explored demographics, surgical experience, complication rates, psychosocial domains, coping mechanisms, financial concessions, institutional support, and burnout. Descriptive statistics were applied. A five-point criterion was used for defining a serious surgical complication (SSC). Categorical variables were summarized as proportions. Unadjusted and adjusted Firth penalized logistic regression was conducted to identify factors associated with burnout.

Outcome measures: Prevalence of emotional burden and burnout RESULTS: Participants were predominantly orthopaedic surgeons (96%), with 86% being fellowship trained. Most practiced in private corporate hospitals (74%). Nearly all (96%) reported psychological suffering after a SSC, with guilt (42%), depression (38%), anxiety (36%), and irritability (30%) frequently cited. Almost all faculties of psyche were affected: general well-being (78%), sleep (80%), driving ability (54%), appetite (60%), and sex life (56%). Multiple domains were affected in 86%. It also interfered with personal relationships with friends (46%), family (62%), colleagues (56%), and other patients (64%). Coping strategies included peer (74%) and mentor support (52%), family engagement (54%), and self-acceptance (64%). Unfortunately, standard coping mechanisms during distress, including music or sports, were inadequate (34% each), while substance use was reported by 34%. Two-thirds (66%) reduced professional fees or institutional charges for affected patients. The availability of emotional support from the family and friends (84%) and absent punitive response from institutions was impressive. Burnout-domain symptoms was common with moderate-to-severe exhaustion in 44%, depersonalization in 40%, and poor professional accomplishment in 48%. In adjusted regression, anxiety after a complication was associated with higher burnout symptoms.

Conclusion: Spine surgeons experience high psychological burden from surgical complications, with widespread burnout symptoms, and reliance on varied, often inadequate and inappropriate coping strategies. Institutional and peer-support programs are urgently needed. The beneficial effects of family & peer support, and mentorship reported by surgeons in handling complications should be strengthened further.